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In the remote corners of Mozambique, a woman’s water breaking doesn’t just signal she’s about to give birth.

It also means she’s likely facing a walk along washboard dirt roads of more than 30 kilometres to make it to the nearest medical centre.

It’s a journey that often proves fatal.

With a healthcare system that’s in tatters by western standards, as many 490 women in Mozambique die for every 100,000 live births, according to U.N. statistics. The situation is better in Bangladesh, where about half as many mothers die during or shortly after childbirth, but both countries still pale next to the likes of Canada, where only 12 women die for every 100,000 births.

Despite receiving billions of dollars worth of aid since its civil war ended in 1992, nearly 20 million people in Mozamique make less than $1.25 per day, meaning they live in what the UN calls “extreme poverty.”

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To be sure, even when pregnant women, victims of the AIDS virus, and other patients ultimately reach a hospital there is no guarantee of survival.

Mozambique has just 2.7 doctors per 100,000 people, according to World Health Organization estimates; Canada has nearly 100 times that many.

It’s a developing-world tragedy that resonated with parishioners at St. James Anglican Church in Ingersoll, Ont.

Shortly before Christmas, the church’s 250 members raised $600 to help buy a bicycle ambulance for villagers in Bangladesh.

“There were many things we could have done, maybe sent a goat to a village, but we wouldn’t know if they’d see the goat and use it for milk, or see it and think there’s dinner,” said Rev. Meghan Evetts, a priest at St. James. “We wanted to help and a bicycle ambulance seemed like a really good, long-term solution to the problems.”

While Canada more often makes headlines for trumpeting big-ticket aid projects such as its financing of the Dahla Dam in Afghanistan, a little-known, modest effort to help pregnant women in Mozambique and Bangladesh has captivated Anglican parishes across Canada. Since 2008, parishes such as St. James have raised about $25,000 to buy bicycle ambulances and Canada’s foreign aid agency CIDA has kicked in another $75,000.

The ambulances cost about $600 apiece and were first rolled out in Mozambique, a country where only 60 per cent of the population has enjoyed access to health services, most of which were destroyed during years of war and have yet to be been rebuilt. Prenatal visits to doctors are almost unheard of in rural Mozambique and fewer than 50 per cent of births have been assisted by trained health workers.

“It brought tears to my eyes when I visited last November and saw the conditions,” Bastos said. “You stop in these villages and see they have no running water. You have families living in a little hut, father and mother, eight little children with no access to school. You look at their future and ask what will happen. It’s that dramatic.”

About 70 bicycle ambulances have been delivered so far in Mozambique and another 50 are expected to be delivered, said Zaida Bastos, a program coordinator with Primate’s World Relief and Development Fund, the Anglican Church of Canada’s charitable agency. In Bangladesh, 30 of the vehicles have been given to communities.

“We were hearing stories about the sick having to walk or be carried to the hospitals from villages far away and by the time they got there they were sicker than when they started their journey,” Bastos said. “We just put our heads together and decided we wanted to build something that would help, could be fixed easily if it breaks down, and was scalable in other countries.”

In the Mozambique communities where the bicycle ambulances have been introduced, maternal mortality rates have dropped by 15 per cent, according to a report filed with CIDA by the Anglican church development agency. The agency also trained midwives and helped to build and refurbish health clinics, which also contributed to the lower mortality rates.

When Bangladeshi aid workers discussed copying the Mozambique model, they did some tinkering, asking for the Canadian donors to commission the construction of tricycle ambulances instead of bicycles.

“Maybe a little more stable,” Bastos said. “I’ve joked that the communities in Mozambique have had the Cadillac of bike ambulances and maybe now the people in Bangladesh have the Rolls Royce.”

The Anglican church’s report to CIDA also highlights a societal change that the bikes have triggered in Mozambique.

“There is a belief in Macau culture that women should not ride bicycles because it encourages extramarital affairs,” the report says. “Nevertheless, a few of the communities that received bicycle ambulances now have women as the bicycle drivers.”

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